The non-portable BrightArm Duo prototype is being studied (SBIR Phase II grant to Bright Cloud International - BCI) for Upper Extremity (UE) motor and cognitive maintenance therapy on CVD survivors who are residents of skilled nursing facilities (SNF). They train using BCI virtual reality (VR) bimanual games, supervised by an Occupational Therapist. The vast majority of CVD survivors live at home and they need a link between earlier clinic-based therapy and subsequent community activities. The goal of this SBIR Phase I project is to demonstrate the feasibility of the proposed BrightBrainer G system for use in home tele-rehabilitation of CVD survivors. The objectives of this project are: 1) to develop BrightBrainer G, a bimanual UE training system that induces a high number of active arm repetitions, has novel hand controllers, self-guided adaptable games and allows remote clinician's review; 2) determine its technology acceptance and clinical benefit on CVD survivors in the chronic phase living at home, based on standardized tests and caregiver feedback. SPECIFIC AIMS 1) Develop the BrightBrainer G UE remote rehabilitation system using novel hand controllers and adaptable games for integrative therapy of elderly CVD survivors living at home. Improve design through a usability study; 2) Study acceptance of BrightBrainer G technology, its clinical benefit and transfer to daily activities when used by CVD survivors living at home. Study will incorporate caregiver feedback. METHODS 1) Construct the BBG system by designing conformal controllers that wirelessly measure 3D hand position and grasp strength, finger extension, provide vibration feedback and integrate biosensors for increased safety. Create bimanual adaptable games and a new database module to store performance data on a secure clinical server for remote monitoring by clinicians; 2) Evaluate BBG usability by 4 elderly volunteers with normal motor function to correct issues in ease of use, ergonomics of hand controllers, and determine satisfaction and perceived benefits; 3) Study feasibility of use be 8 elderly CVD survivors undergoing a 4 week at-home intensive rehabilitation (5 sessions/week). Include individuals age 60 to 80 with 9 months or more post-onset of CVD and normal cognition or mild cognitive impairments (MCI). Benchmark success using UE functional gain, improved executive function, and technology acceptance; 4) enroll caregivers to indicate degree of assistance needed in BBG use at home. They will evaluate generalization of training effects from VR games to real-life activities independence by periodically filling the subjects' standardized Upper Extremity Functional Index form [Stratford 2001]. NIH RELEVANCE: Total US costs of CVD are $105 billion and expected to grow to $240 billion by 2030. This project will improve UE function, cognition and quality of life and provide continuity of care for elderly CVD survivors living at home. Other populations may also benefit (TBI, cerebral palsy or those with MCI).